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Osteoporotic spinal compression fractures

Last reviewed: 10 Nov 2023
Last updated: 20 Jun 2023



History and exam

Key diagnostic factors

  • advanced age
  • ethnicity
  • previous osteoporotic vertebral compression fracture
  • acute back pain
  • asymptomatic
More key diagnostic factors

Other diagnostic factors

  • history of long-term corticosteroid use
  • bone-losing medications
  • kyphotic deformity
  • loss of lumbar lordosis
  • localized tenderness
  • loss of standing height
  • loss of sagittal balance
Other diagnostic factors

Risk factors

  • older age
  • previous osteoporotic vertebral compression fracture
  • low body weight
  • recent weight loss
  • family history of low bone mass/osteoporotic fractures
  • smoking
  • white or Asian race
  • postmenopausal status
  • secondary amenorrhea
  • alcohol (>2 units/day)
  • corticosteroid use
  • glucocorticoid excess
  • hyperthyroidism
  • vitamin D deficiency
  • low calcium intake
  • rheumatoid arthritis and other autoimmune connective tissue diseases
  • endocrine disorders (e.g., hypogonadism, hyperparathyroidism, hyperprolactinemia, acromegaly, hypercortisolism, hyperthyroidism)
  • gastrointestinal diseases (e.g., inflammatory bowel disease, celiac disease, malabsorption syndromes, post-bariatric surgery)
  • liver diseases (e.g., biliary sclerosis, sclerosing cholangitis, alcoholic cirrhosis, autoimmune hepatitis)
  • dietary disorders (e.g., anorexia nervosa/bulimia, inadequate diet, total parenteral nutrition)
  • neurologic disorders (e.g., stroke, multiple sclerosis, Parkinson disease, spinal cord injury, long-term immobilization)
  • renal disease
  • type 1 diabetes mellitus
  • organ transplantation
  • bone-losing medications
More risk factors

Diagnostic investigations

1st investigations to order

  • plain x-rays
More 1st investigations to order

Investigations to consider

  • CT spine
  • MRI spine
  • technetium-99m (Tc-99m) whole-body bone scan (bone scintigraphy)
  • single-photon emission computed tomography (SPECT)/CT
  • bone densitometry scan
  • CBC
  • bone profile (including serum calcium and alkaline phosphatase)
  • C-reactive protein
  • blood cultures
More investigations to consider

Treatment algorithm


anterior column involvement only

multiple column involvement



Nasir A. Quraishi, LLM, FRCS

Consultant Spine Surgeon & Honorary Clinical Associate Professor

Centre for Spinal Studies and Surgery

Queen’s Medical Centre




NAQ declares that his institution has received research support from Medtronic.

Opinder Sahota, FRCP, DM, FHEA

Professor of Orthogeriatric Medicine & Consultant Physician

Queen's Medical Centre

Nottingham University Hospitals NHS Trust




OS declares that he has no competing interests.

Jeremy Fairbank, MD, FRCS

Professor of Spine Surgery

University of Oxford

Nuffield Orthopaedic Centre




JF declares that he has no competing interests.

Peer reviewers

Kee D. Kim, MD

Professor of Neurological Surgery

University of California




KDK declares that he has no competing interests.

Micky Malhotra, MBBS, DTCD, MD, MRCP

Consultant Physician

Wrightington, Wigan & Leigh NHS Foundation Trust




MM declares that he has no competing interests.

  • Osteoporotic spinal compression fractures images
  • Differentials

    • Muscular pain
    • Spinal stenosis
    • Pathologic fracture
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: management of vertebral compression fractures
    • Guidance for the management of symptomatic vertebral fragility fractures
    More Guidelines
  • Patient leaflets

    Osteoporosis: what treatments work?

    Osteoporosis: questions to ask your doctor

    More Patient leaflets
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